P1177The spectrum of restrictive eating in Inflammatory Bowel Disease: A systematic review of prevalence and associated factors

Abstract Background Food-avoidance to manage gastrointestinal symptoms is common among people living with Inflammatory Bowel Disease (IBD)1. When dietary restriction becomes more persistent, rigid or increasingly restrictive, disordered eating behaviours (DEB) or even clinically defined eating disorders (ED) can develop3,4. In a population already at increased risk of worse mental wellbeing and adverse clinical outcomes5, DEB represents a significant and under-recognised concern. The aim of this review was to synthesise evidence on the prevalence and incidence of food avoidance, DEB and ED and to identify potential risk factors associated with disordered eating behaviours in people living with IBD. Methods Six databases were comprehensively searched (CENTRAL, EMBASE, MEDLINE, APA PsycINFO, CINAHL and AMED) from inception to September 2025. Eligible studies were peer-reviewed, quantitative studies examining at least one measure of restrictive eating behaviours (food avoidance, DEB or ED) and/or associated factors. Due to the heterogeneity of the data, a narrative synthesis was undertaken. Results Of 6,973 records identified, 31 met the inclusion criteria. Prevalence estimates for restrictive eating behaviours varied widely across studies, with food avoidance reported in 27.5-90% of participants across studies and prevalence of DEB ranging from 4.8%-53%. Restrictive eating behaviours were assessed using a range of validated and non-validated tools. Potential risk factors most frequently examined and found to be significantly associated with higher levels of restriction included female sex (6/31 studies), the presence of active disease inflammation (6/31) and a diagnosis of Crohn’s disease (7/31). Psychosocial variables were examined less frequently in the literature but, when included, were consistently associated with restrictive eating behaviours (e.g. gastrointestinal specific anxiety, distress). Conclusion Restrictive eating behaviours are a pertinent issue in people living with IBD. The literature highlights a range of clinical, demographic and psychological factors associated with these behaviours. However, inconsistent terminology, measurement approaches and disease-specific thresholds for determining ‘unhelpful’ eating behaviours in IBD limit the ability to compare across studies. Future research should prioritise clearer, more meaningful definitions and explore potentially modifiable psychosocial factors to support earlier identification and intervention. References: 1. Godny, L., 36(1):336-377. 3. Riehl ME, Scarlata K. Understanding Disordered Eating Risks in Patients with Gastrointestinal Conditions. J Acad Nutr Diet. 2022;122(3):498-499. doi:10.1016/j.jand.2021.03.001 4. Simons M, Issokson K. From Food Fears to Food Freedom: How Do We Best Manage Restrictive Eating in Inflammatory Bowel Disease? Crohns Colitis 360.Oxford University Press. 2025;7(2). doi:10.1093/crocol/otaf019 5. Barberio B, Zamani M, Black CJ, Savarino E V., Ford AC. Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(5):359-370. doi:10.1016/S2468-1253(21)00014-5 Conflict of interest: Harding, Sophie: None Seaton, Natasha: None McIlroy, Suzanne: Department of Psychology Lomer, Miranda: Grant: Crohn’s and Colitis UK, GSTT charity, NIHR-HTA Personal Fees: Abbvie, Janssen, Mayoly Other: Course Director of low FODMAP courses for dietitians Moss-Morris, Rona: None Wileman, Vari: None